Advanced imaging to navigate the nervous system

According to experts, the technology gives surgeons the ability to see a patient’s anatomy in three dimensions and accurately pin-point a location in the brain or spinal cord.
Neurosurgery involves the surgical treatment of disorders which affect any portion of the nervous system.
Neurosurgery involves the surgical treatment of disorders which affect any portion of the nervous system.

BHUBANESWAR: As technology makes great inroads into healthcare, the success rates of surgeries and procedures/therapies have gone up manifold over the years. One such cutting-edge approach that has revolutionised healthcare is neuronavigation-guided surgery for brain and spinal procedures, which utilises advanced imaging technology to enhance precision, accuracy, and safety.

According to experts, the technology gives surgeons the ability to see a patient’s anatomy in three dimensions and accurately pin-point a location in the brain or spinal cord with the aid of diagnostic imaging tech such as CT and MRI, or intraoperative images from ultrasound, MRI. It also enables surgeons to track instruments in relation to the patient’s anatomy and track the anatomy itself during a surgical procedure.

“Neuronavigation helps and guides neurosurgeons to the deeply seated tumours in the shortest path, avoiding important critical normal structures of the brain and spine, during surgery like a real time assistant. It is an excellent way for navigating the brain and spine, just like a compass in a sea of vital structures of brain and spine,” said Dr Asish Patnaik, professor, neurosurgery, AIIMS, Bhubaneswar.

The need for precision

Neurosurgery involves the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord, and peripheral nervous system. Neuronavigation has gained popularity, especially for neurological disorders that need to be accessed with pin-point precision for greater success.

Before the surgery, specialised software and imaging techniques are used to create a virtual map of the patient’s brain or spinal anatomy. It enables accurate localisation of target structures, facilitates optimal trajectory planning, and enhances surgical outcomes. Over the past decade, neurosurgeons have been accustomed to intraoperative surgical navigation to improve outcomes and reduce morbidity. Although it may seem complex in the beginning, it becomes user-friendly gradually.

“Even as traditional approaches were effective to a certain extent, they had limitations in terms of precision, accuracy, and the ability to navigate complex anatomical structures, particularly in cases involving deep-seated lesions or intricate spinal pathologies. The introduction of neuronavigation technology revolutionised brain and spinal surgery by providing surgeons with real-time, high-resolution imaging and precise navigation capabilities,” said Dr Patnaik.

Real-time assistance during surgery

This method utilises a set of computer-assisted technologies to guide or navigate within the borders of the skull or vertebral column during surgery. It is synonymous with image-guided and computer-aided surgery. “Before the new technique was introduced, brain and spinal surgeries relied primarily on the surgeon’s anatomical knowledge, while preoperative imaging such as MRI or CT scans provided intraoperative visuals and tactile feedback. The new tool provides numerous advantages like more accurate planning and higher precision for intraoperative localisation of different anatomical structures by offering greater surgical safety,” said Dr Amit Jaiswal, senior consultant, neurosurgery and spinal surgery, AMRI Hospitals.

He added that neuronavigation allows surgeons to determine the precise location and assess margins, and helps in planning a surgical approach to the targeted lesion without affecting the surrounding neurovascular structures. During the procedure, specialised instruments equipped with tracking sensors are used to visualise the patient’s anatomy in real-time on a computer screen. The surgeon utilises this navigation system to guide the surgical instruments to the intended target with high precision.

“Neuronavigation allows surgeons to precisely locate and target lesions or abnormalities within the brain or spine. This accuracy minimises the risk of damaging critical structures, such as blood vessels or functional areas of the brain, during the procedure,” said Dr Samir Kalra, senior consultant and professor of neurosurgery at Sir Ganga Ram Hospital and Ganga Ram Institute of Medical Education and Research.

Minimise risks, quicker recovery

It is particularly beneficial for patients with complex brain and spinal pathologies, including brain tumours, Parkinson’s disease, epilepsy, cerebrovascular disorders, dystonia, spinal cord tumours, traumatic brain injuries and degenerative spinal conditions. Patients with lesions located in eloquent or critical areas of the brain or spine, where preservation of function is paramount, often benefit significantly from neuronavigation-guided approaches.

Neurosurgeons have been using surgical navigation for a wide variety of minimally invasive endoscopic approaches to the skull base and spinal procedures. Although the core technology has not changed since its introduction, clinical experiences have grown considerably. The procedure is done mainly in four phases - preoperative planning, image registration, surgical navigation and intraoperative monitoring.

Continuous feedback from the navigation system ensures that the surgical plan is executed accurately, allowing for adjustments as needed.

“The new strategic technique helps preserve vital structures and function, reducing the likelihood of postoperative deficits or complications. As a result, post-operative quality of life for patients is improved following surgery by avoiding unintended injury,” Dr Kalra added.This technique allows doctors to track the exact position of surgical tools relative to the patients anatomy during procedure. “Neuronavigation is a transformative technology like a GPS system specifically designed for the brain and spinal area. Throughout the procedure, the system tracks the position of surgical instruments relative to the patient’s anatomy. This constant feedback ensures the utmost safety and accuracy throughout the entire surgery,” said Dr Ravi Gopal Varma, director of Aster Global Institute of Neurosciences, and lead consultant at Aster CMI Hospital, Bengaluru.

Cost and benefits

The technique is now available across cities in the country, offering patients access to state-of-the-art neurosurgical care at competitive costs, ultimately contributing to improved outcomes.

The cost of neuronavigation-guided brain and spinal surgery can vary depending on several factors, including the complexity, the technology used, the surgeon’s expertise, and the hospital facilities. On average, the cost ranges from Rs 2.5 lakh to Rs 5 lakh for brain procedures and Rs 3 lakh to Rs 6 lakh for spinal procedures. There is no extra cost for neuronavigation techniques at government institutions like AIIMS. Earlier, hospitals were charging more as the cost of the equipment was several crores. Now both the cost of the equipment and surgery have dropped significantly. “The technology is available in top neurosurgical centres across the country. Though it requires a one-time investment for the hospital, there is only minimal recurring cost for patients,” said Dr Arjun Chacko, senior consultant, neurosurgery, Rajagiri Hospital, Ernakulum.

(With inputs from Ashish Srivastava @ New Delhi, Rishita Khanna @ Bengaluru, and Anna Jose @ Kochi)

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